Diabetes of the dog Flashcards
What cells are produced at the islet of Langerhans?
A: glucagon
B: insulin
D:somatostatin
F: Pancreatic polypeptides
Hypoglycemic counter-regulatory hormones
Epinephrine
Cortisol
Glucagon
Growth Hormone
Type 2 diabetes
Insulin resistance
Due to genetics, impaired insulin secretion, islet amyloid and environment (obesity)
Type 1 diabetes
Genetics + immune system (juvenile)
Progressive and complete
What defines DM in dogs?
Hyperglycemia
Glucosuria (renal threshold of glucose)
180-220 mg/dL in dogs
Insulin dependent DM (IDDM)
All dogs
↓ insulin, no insulin release after glucose admin, need exogenous insulin
Reduction in size and # of B cells
Non-insulin dependent DM (NIDDM)
Obesity-induced carb intolerance
Uncommon in dogs (hyperadrenocorticism)
Signalment for DM
4-14y (peak @ 7-10y)
Female > male
Juvenile DM
Rare and concurrently exocrine pancreatic insufficiency
2-6m of age
shepherds, keeshounds
CS of DM
PU/PD/PP
WL with good appetite
Cataract, KCS
Thinning/ unkempt haircoat, hepatomegaly, m weakness and lethargy
Chemistry of DM
Hyperglycemia, -cholesterolemia, -trygliceridemia
Lipemia, ↑ ALT and ALP
Urinalysis of DM
Glycosuria
Variable ketonuria
Proteinuria and bacteriuria (UTI)
USG <1.025
Diagnostic testing of DM
Frutosamine (average glucose over 2w)
Glycosylated hemoglobin (A1C)
DDX for hyperglycemia glucosuria or insulin resistance
Hyperadrenocorticism
Hypersomatotropism (acromegaly)
Pancreatitis
EPI
Fanconi syndrome (glucosuria only, normal blood glucose)
Insulin components
Amphorus: soluble, short- acting component
Cystalline: less soluble, long acting
Short-acting insulin
Regular insulin (Humulin R or Novolin R)
Lispro (humalong) and Aspart (novolong)- human
Regular insulin
Given IV, IM, SC
Used to tx DKA in vet med
Onset of action 10-30 min
Duration of action 3-10hrs, depending on route
Intermediate- acting insulin
NPH (Humulin N or Novolin N)
Porcine origin Lente (vetsulin)
PZI insulin
NPH
Contains protamine and zinc to delay absorption of insulin
Recombinant human DNA tech (preventing antiinsulin abs)
Porcine origin Lente (vetsulin)
K9 and porcine insulin have identical aa sequence (eliminates antiisulin abs)
35% amorphous and 65% crystalline
PZI insulin
ProZinc= protamine zinc recombinant human insulin
More consistently absorbed and long duration than NPH cats
Glargine (long lasting)
Produced by recombinant DNA tech using E. coli
Results in delayed, prolonged, constant absorption of insulin
Insulin Detemir (levemir)
Long-acting, recombinant insulin analogue
Slow absorption and long effect due to fatty acid modification → binds reversibly to albumin
When would you use insulin detemir
Bigger dogs who aren’t regulated using other insulin types
Basal insulins
Long duration of action
Insulin gargine (Toujeo)
Insulin degludec (tresiba)
Goals of therapy
Don’t make your patient hypoglycemic
Elimination of CS
Dietary Therapy
Reduce weight in overweight or obese animals
Complex CHOs, moderate to high fiber (controls hyperglycemia)
What causes poor glycemic control in stable diabetics (physiologically)
UTI (most common cause)
Hyperadrenocorticism
Pancreatitis
Neoplasia
bacterial pyoderma, otitis
What causes poor glycemic control in stable diabetics (owners)
Old insulin
Inappropriate handling or administration
Insulin ab development (rare)
Complications of DM
Poor glycemic control in stable diabetics
KCS
Diabetes induced cataracts (>60%): uveitis, synechia, glaucoma
